home-based services program presented by lisa lew clearbrook january 9 th, 2015
TRANSCRIPT
HOME-BASED SERVICES PROGRAMPresented by Lisa Lew
ClearbrookJanuary 9th, 2015
Clearbrook: How it all began
1955: 5 families in
a church basement
1960s: Vocational
Services
1970s: Residential
Services and CHILD
Program
1980s: Expansion
of Residential
Services
1990s: Clearbrook Clinic, CILA, Respite, and
CFC
2000: Plaza opens, HBS
expands
Largest provider of home-based services in IL
6000 served in 13
counties
Clearbrook Today
We serve individuals throughout their lifespan.
Children’s Services
Adult Day and Residential Services
Senior Services
Home-Based Services
Clinical Services
Family & Community Autism Resource Rooms
http://www.clearbrook.org/page.aspx?pid=430
Provides autism resources that include consultation, visual communication systems, and a vast library resources at no cost. Two locations: Arlington Heights and Northbrook
Arlington Heights is open Monday, Tuesday, & Thursday from 8:30am-3pmWednesday, Friday, evening & weekend hours are also available byappointment.
Northbrook is currently open by appointment only.
For additional information, contact Tracy Hellner, Autism Resource Specialist,
847-392-2812 ext 31 [email protected]
Transition Services: Building Bridges
http://www.clearbrook.org/page.aspx?pid=373
Assists families and professionals in transitioning students with intellectual/developmental disabilities to the world of adult services. The following six agencies use a collaborative approach to serve these individuals: Clearbrook, Elim Christian Services, Helping Hand Center, PACTT Learning Center, Park Lawn Services and Seguin Services.
Who is served by Building Bridges?• Students aged 14 through 25 with a intellectual/developmental disability, and their families.
Provides assistance in these areas:• Entry into Developmental Disabilities system (PAS, PUNS)• Financial/Medical Benefits (SSI, Medicaid)• Legal Resources (Guardianship, Special Needs Trust, Power of Attorney, Wills)• Program Funding (Waivers, Residential Program, Day Program, DORS)• Training/Coaching (Parent Education & Support, Options for Community Services, Self-Advocacy)
For additional information, contact Michelle Schwartz, Transition Outreach Specialist
847-385-5354 or [email protected]
Clearbrook Programs: Adult Services
Children’s
Services
Adult Day and Residential Services
Senior Services
Home-Based Services
Clinical Services
ADULT DAY SERVICES
http://www.clearbrook.org/page.aspx?pid=377
Developmental Training (DT)- Schaumburg, Gages Lake & PalatineAutism Day Services (CAP)- Palatine & NorthbrookSenior Day Services (ACES)- Rolling MeadowsEmployment & Training- Arlington Heights & PalatineCHOICE Program- EvanstonPURSUIT Program- Rolling MeadowsPartners in Adult Learning (PAL) Program- Palatine
For additional information contact the Admissions Department:Melinda Meyer 847-385-5328 [email protected]
Tracy Martin 847-385-5018 [email protected]
Home-Based Services Program (HBS)
http://www.clearbrook.org/programs/homebased
This program provides active treatment based services to children and adults with
intellectual/developmental disabilities and their family.
The Program: Provides support in the comfort and familiarity of a home,
educational setting and/or community environment. Provides services to promote skill development and
community integration. Coordinates with other programs in which family members
may participate. Offices in Arlington Heights, Northbrook and Downers Grove Currently serves over 1000 individuals in 13 Illinois counties.
For additional information, contact Hollis Gorrie, Program Director at 847-385-5041 or [email protected].
Adult Residential Services Intermediate Care Facilities for Individuals with Intellectual/Developmental (ICF/IID) • Lattof Commons (92 clients, Rolling Meadows) • Fairfax (16 clients, all male, Rolling Meadows) • Wilke (16 clients, all female, Rolling Meadows) • Wright Home (16 clients, Gurnee)
Community Integrated Living Arrangement (CILA) • 35 locations throughout the north & northwest suburbs and the city of Chicago
For additional information, please contact Admissions:Melinda Meyer 847-385-5328 [email protected] Tracy Martin 847-385-5018 [email protected]
Adult Clinical & Behavior Services
ADULT CLINICAL & BEHAVIOR SERVICES
Behavioral Services Psychological/Counseling Services Speech Therapy Occupational Therapy Physical Therapy Medical Consultation
For additional information, contact Mark Ammer, BCBA, Director of Clinical Services at 847-310-9141 ext. 231 or [email protected]
http://www.clearbrook.org/page.aspx?pid=376
What are the Home-Based Support Programs?
Children’s Home-Based Support
WaiversAdult Home-Based Support
What is a Waiver?
The Children’s and Adult Home-Based Support Services Programs (HBSS) for people with developmental/intellectual disabilities are both part of “waiver” programs.
A waiver means they are funded with a mix of funding from the State of Illinois and the Federal Government. The State of Illinois pays the providers of supports and services. Then the Federal Government reimburses the State 50 cents for every dollar they have spent. In other words, they each pay half.
STATE FEDERAL
Waivers allow states to design programs for special populations using Medicaid.
Most adults with severe disabilities have lowincome and qualify for Medicaid
Illinois has agreed to ignore the incomerequirement for families of minor children in theHBSSP
What’s the scoop on this 1115
Medicaid Transformation
Waiver I keep hearing about?
• In Illinois, home and community-based services are compartmentalized under nine separate waivers, three departments and numerous divisions within departments.
• Savings derived from merging the nine waivers will be reinvested into rebuilding the Home & Community Based System, especially in Behavioral Health and Developmental Disabilities.
https://www2.illinois.gov/gov/healthcarereform/Pages/1115Waiver.aspx
Specifically, Illinois seeks to accomplish the following through the Path to Transformation Waiver: Rationalize service arrays and choices so that they are based on beneficiary needs and preferences to remain as independent as possible, rather than disability or condition Increase flexibility and choice for beneficiaries Support development and expansion of community based options Reduce waiting lists for waiver services Develop outcome-based reimbursement strategies that emphasize quality of care and align payments with the goals of the program Reduce administrative complexity and cost inherent in managing nine separate waivers
What’s the scoop on this 1115
Medicaid Transformation
Waiver I am hearing about?
The Application Process
DHS selects adults and children for new enrollment from the PUNS (Prioritization of Urgency of Need for Services) database.
You can get more information on the PUNS Selection Process from the DHS Website
http://www.dhs.state.il.us/page.aspx?item=41131
Urgency of Need
Length of time on database
Statewide geographic
distribution
Current living arrangement
LIGAS CONSENT DECREE
Signed in 2011• Guarantees that, over the next 6 years, all
persons currently living in ICFDDs who wish to move out into CILAs (or home-based services) may do so.
• Guarantees that, over the next 6 years, the State will provide CILA or home-based services to 3,000 ADULTS now living at home.
LIGAS UPDATEThird Annual Report of the Ligas Court Monitor (9-30-14)
http://www.dhs.state.il.us/page.aspx?item=74367
In summary, 4,306 letters have been sent to Ligas waiting list class members over the past three years.
As of September 1, 2014, the status of provision of services for those individuals found eligible as waiting list class members is as follows:
Services have been initiated for 1,969 class members. An additional 89 class members have received funding awards, and services
are about to begin soon. Packets for another 24 individuals have been completed, and sent to DHS
for funding approval. 499 individuals are in the process of receiving or have completed Level II
screening by PAS agencies, and requests are being processed. Initial contact has been made with an additional 146 individuals who have
confirmed that they have requested services.
If Selected….Must Have
Medicaid
Clinical Waiver
Eligibility Criteria
Waiver Clinical Eligibility Criteria for Adult’s with a Developmental Disability
18 or older Resident of Illinois and living in Illinois Enrolled in Medicaid in Illinois Have a developmental disability, either mental retardation or related condition determined disabled according to the provisions of
Title II of the Social Security Act, Federal Old-Age, Survivors and Disability Insurance Benefits (42 U.S.C. 421).
Eligible for ICF/MR level of service Not in need of nursing assessment, monitoring, intervention & supervision of
their condition or needs on a 24 hour basis not be receiving services in a nursing facility, skilled nursing facility, Intermediate
Care Facility for people with Developmental Disabilities (ICF/DD), state-operated facility, skilled nursing facility for pediatrics, hospice facility, sheltered care facility, assisted living facility or hospital.
Not receiving services funded by another Medicaid Waiver program
THE AWARD LETTER• Services can begin once you • receive the award letter
• Effective date is listed on the letter
Now What?
Contact your Service Facilitator
Schedule a HOME VISIT
Learn about the Program
What’s a SERVICE FACILITATOR?
Service facilitation includes case management services that assist participants and families in gaining access to needed Waiver and other Medicaid State Plan services, as well as medical, social, educational and other services, regardless of the funding source for the services.
Service Facilitators are responsible for day-to-day oversight and administration of the service plan and for ensuring participant health, safety and welfare.
How do I find a Service Facilitator?
Get List
from PAS/I
SC Agen
cy
Interview Agencie
s
Select a Provider
THE PROCESSIdentify Needs
Write a Service Plan
Find Services
Monthly Budgeting
Identify Needs
Child/Adult
Family Members
ISSAService Facilitator
Other Providers
WRITE A SERVICE PLAN
What’s a Service Plan?A written plan to identify the supports and services the individualneeds and wants
Goals are written to assist the individual to live successfully in thecommunity
Ensure providers understand and fulfill their roles and responsibilities
Ensure funds are used in the best interest of the individual.
The process must be as simple as possible so that all participants can understand their roles
Service plans are completed within 30 days of service initiation and updated at least annually by the service planning team. They should also be reviewed and revised as needed by the
Service Facilitator.
Services Provided
Adjust ISPMonitor goals
SERVICE PLANS ARE IMPORTANT
NO SERVI
CE PLAN
NO SERVICES
BUDGETINGHow much funding is available?
• The amount is equal to two times whatever SSI is that year.
• Currently SSI is $721 / 2015= $733• Children’s monthly allocation of HB funds is
$1,442/ 2015= $1466 ($24 increase)
Children’s3-18 years old
• If the participant is still in school, he or she has access to supports and services with a cost of up to two times SSI.
• $1,442/ 2015= $1466 ($24 increase)
Children’s19-22
Still in schoolAdult18 and older
• The amount is equal to three times whatever SSI is that year.
• Currently SSI is $721/2015= $733• Adult monthly allocation of HB funds is• $2,163/2015=$2199 ($36 increase)
DDD Waiver Manualhttps://www.dhs.state.il.us/page.aspx?item=45227
• Introduction• Participant Eligibility and Waiver Program Enrollment• Waiver Services• Table - Available Services by Waiver Program • Individual Service Plan• Self-Directed Services and Individual Budgeting• Provider Requirements• Provider Enrollments and Qualifications• Summary of Specific Provider Qualifications and
Credentials• Service Authorization and Prior Approval• Waiver Service Rates• Waiver Service Billing Guidance• Billing Guidance by Service Type • Appendices (Forms and Instructions)
What Service’s are Covered?Service Adult Waiver Children’s Support HBS WaiverIND. SERVICE & SUPPORT ADVOCACY X XDAY HABILITAITON & OTHER DAY PROGRAM SERVICESDevelopmental Training (DT) X Temporary Intensive Staffing * In DT Only
Supported Employment (SEP) * X Adult Day Care * X Regular Work/Sheltered Employment X
Other Day Program * BEHAVIOR SERVICESBehavior Intervention and Treatment X X
Behavior Counseling X Psychotherapy X THERAPIESPhysical Therapy * + X Occupational Therapy * + X Speech Therapy * + X ADAPTIVE EQUIPMENT, ASSISTIVE TECHNOLOGY, VEHICLE MODIFICATIONS, HOME ACCESSIBILITY MODIFICATIONS *
Adaptive equipment * X XAssistive Technology * X XHome Accessibility Modifications * X XVehicle modifications * # X XHOME-BASED SUPPORT SERVICESService Facilitation X XPersonal Support X XTemporary Assistance * X XNursing + X Emergency Home Response Services X
Transportation (Non-Medical) X Training and Counseling Services for Unpaid Caregivers X X
Out-of-Home Respite (89D) X X* Services that require both authorization and prior approval are marked with an asterisk.# Vehicle Modifications are part of the transportation component of the residential rate.+ These services are available for children up to age 19 21 through the Medicaid State Plan.
DDD FY13 Rates Table - Effective October 1, 2012DDD PROGRAM NAME Program
CodeHCBMedicaidWaiver
ServiceUnitType
MaximumPer FY
FY2013Rate
FY2013Rate
DAY PROGRAMS - POS (Any combination of Day Program codes can be a maximum of 1,100)Developmental Training 31U Y Client Hour 1,100 $10.39 $11,427Developmental Training - Advance & Reconcile (No new authorizations)
31A Y Client Hour 1,100 $10.39 $11,427
Regular Work 38U N Client Hour 1,100 $10.39 $11,427Supported Emp. (Group) No Job Coach
36G Y Client Hour 1,100 $11.63 $12,790
Supported Emp. (Group) Job Coach
39G Y Client Hour 1,100 $11.63 $12,790
Supported Emp. (Indiv.) No Job Coach
36U Y Client Hour 1,100 $13.03 $14,337
Supported Emp. (Indiv.) Job Coach
39U Y Client Hour 1,100 $13.03 $14,337
Adult Day Care 35U Y Client Hour 1,100 $12.34 $13,574Other Day Program 30U N Client Hour 1,100 $10.39 $11,427At-Home Day Program 37U Y Client Hour 1,100 $10.39 $11,427
WAIVER SUPPORTIndiv Serv & Support Advocacy (ISSA)
50D Y - Admin. Client Hour 25 $40.01 $1,000
THERAPIESPhysical Therapy 52P Y Client Hour 52 $36.00 $1,872Occupational Therapy 52O Y Client Hour 52 $36.00 $1,872Speech Therapy 52S Y Client Hour 52 $36.00 $1,872
DDD FY13 Rates Table - Effective October 1, 2012Behavior Intervention and Treatment
56U
Level 1 - Licensed Professional - Statewide Rate
L1 Y Hour 66 (Any combination of L1 & L2)
$77.86 $5,139
Level 2 - Other Credentials or No Level Specified - Statewide Rate
L2 Y Hour 66 (Any combination of L1 & L2)
$62.28 $4,110
Individual Counseling 57U Y Client Hour 60 (Any combination of 57U, 57G, 58U, 58G)
$30.57 $1,834
Group Counseling 57G Y Client Hour 60 (Any combination of 57U, 57G, 58U, 58G)
$10.19 $611
Individual Therapy 58U Y Client Hour 60 (Any combination of 57U, 57G, 58U, 58G)
$38.21 $2,292
Group Therapy 58G Y Client Hour 60 (Any combination of 57U, 57G, 58U, 58G)
$12.74 $764
HOME-BASED SUPPORTSHBS Service Facilitator (children & adults)
55A Y Hour 24 or 2/Mo. Min. $40.01 Annual Max. $$
HBS Training for Unpaid Caregivers (children & adults)
55B Y Event Mo. Max. varies Annual Max. $$
HBS Counseling for Unpaid Caregivers (children & adults)
55C Y Hour Mo. Max. $30.57 Annual Max. $$
HBS Personal Support (children & adults)
55D Y Event Mo. Max. varies Annual Max. $$
HBS Nursing - Registered Nurse (adults only)
55N Y Hour 365 or Mo.Max $$ $31.90 Annual Max. $$
HBS Nursing - Licensed Practical Nurse (adults only)
55P Y Hour 365 or Mo.Max $$ $28.90 Annual Max. $$
HBS Transportation (adults only) 55T Y Events/Miles $500/Mo. $0.38 Annual Max. $$
HBS Emergency Home Response (adults only)
55W
Level 1 - System Installation L1 Y Event 1/State FY $30.75 $31Level 2 - Monthly Rate for Monitoring
L2 Y Event 1/Month $28.70 Annual Max. $$
OTHER SUPPORTS AND SERVICESCrisis Services (Adult HBS only) 53C Y Hour 60 Consecutive
Daysvaries varies
Adaptive Equipment 53E Y Event $15,000/5 Yr. Max (Any combination of 53E, 53T, 53H, 53V)
varies varies
Assistive Technology 53T Y Event $15,000/5 Yr. Max (Any combination of 53E, 53T, 53H, 53V)
varies varies
Minor Home Accessibility Modification
53H Y Event $15,000/5 Yr. Max (Any combination of 53E, 53T, 53H, 53V)
varies varies
Temporary Intensive Staffing - Day (DT only)
53D Y Hour Tied to DSP wage rate
$12.86 varies
Temporary Intensive Staffing - Residential (60D only)
53R Y Hour Tied to DSP wage rate
$12.86 varies
Minor Vehicle Accessibility Modification
53V Y Event $15,000/5 Yr. Max (Any combination of 53E, 53T, 53H, 53V)
varies varies
Service Facilitation - HBSS MH Adults
69B N Hour 48 $40.01 $1,921
DDD FY13 Rates Table - Effective October 1, 2012
Department of Human Service (DHS)Developmental Disabilities Services (DDD)
https://www.dhs.state.il.us/page.aspx?item=29733
• Life Choices Project - What is this All About? • Home-Based Support Fiscal/Employer Agency Change• How Do I Apply?
Search the DHS Office Locator for the PAS/ISC agency closest to you. https://www.dhs.state.il.us/page.aspx?module=12&officetype=&county=
• What Services May Be Available?– Residential Living Arrangements– In-Home Supports– Day Services– Other Supports– Support Service Teams
• Provider Information– Provider Information: Provider by Service Type, Reviews, Administrative Actions– Developmental Disabilities Waiver Providers by Program Type
• More Information & Resources– Family & Care Giver Resources– Ligas– DDD Information Bulletins– Disability Resources
Family Support Network
Frequently Asked Questions
Regarding the Children and Adult Home-Based Support Services Programs
*Updated February 2014
http://familysupportnetwork.org/wp-content/uploads/2014/02/HBSSP-FAQ-2014.pdf
Lisa LewClearbrook
Home Based Services Program847-778-3675